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G0438 and G0101 done on same visit

  1. #1
    Sierra Vista AZ Hummingbirds
    Question G0438 and G0101 done on same visit
    Medical Coding Books
    How do you code a pelvic/breast exam G0101 done on the same visit as the annual wellness visit G0438? Would it be G0438-25 or do I need modifier 59? Is the AWV considered and E&M or a proceedure code? Billed both without any modifiers and the G0438 was denied. Anybody know the answer? Thanks.

  2. #2
    East Valley Kachina Coders
    Question G0438 and G0101 done at the same visit
    I just came across one with these codes and was looking for an answer also. I checked the CCI on the G0101 and it does not list it being able to be billed out with the G0438 but since it is such a new code I didn't think it would be totally updated yet. Can you tell me what the Denial code was from Medicare? That could be a clue as to how to bill it.

  3. #3
    Sierra Vista AZ Hummingbirds
    Lightbulb G0438 Payments being held up
    I think the reason they didn't pay the G0348 is that now our Medicare FI says they are holding the payments for G0348 until after April 1. We also heard Medicare RR is holding the payments for the new AWV until after April 1 as well.

  4. Default
    Well I have accidentally billed both together and the denial I get is that G0101 is included in the G0438? Not sure if that helps.

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